Respiration and ECG

There are two influences of respiratory activity on the electrocardiogram (ECG). The first influence is characterized by the mechanical relationship between the diaphragm and heart. The second influence is a consequence of respiratory action on the vagus nerve and is known as Respiratory Sinus Arrhythmia (RSA).

The position and movement of the diaphragm determine the position of the heart because the pericardium is firmly attached to the central tendon of the diaphragm. With deep inspiration, the diaphragm contracts and becomes flatter and less dome-shaped. As it does, the heart descends, moves backward, and rotates to the right so that it becomes narrower and more vertical. The apex beat is lower and more medial. During deep expiration, the diaphragm relaxes, elevates, and becomes more dome-shaped, and movements of the heart are the converse of those that occur during deep inspiration. The degree of the directional movements of the heart during quiet breathing is similar, but reduced, compared to deep breathing and, in some persons, may be hardly noticeable. Diaphragmatic breathing cyclically affects the position of the heart, thus modifying the ECG.

Heart rate increases during inhalation and decreases during exhalation. Heart rate is normally controlled by centers in the medulla oblongata. One of these centers, the nucleus ambiguus, increases parasympathetic nervous system input to the heart via the vagus nerve. The vagus nerve decreases heart rate by decreasing the firing rate of the sinoatrial (SA) node. The SA node is the “pacemaker” of the heart. Upon expiration, the cells in the nucleus ambiguus are activated and heart rate slows down. In contrast, inspiration triggers inhibitory signals to the nucleus ambiguus and consequently the vagus nerve remains unstimulated. When recording the ECG, this phenomenon is experienced as subtle changes in the R-R interval that appears synchronized with respiration. This is the time period between two “R” waves on an electrocardiogram. The R-R interval associated with the ECG is shortened during inspiration and prolonged during expiration.